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<br />. III IIIIIIIII IIII III <br />e,Z, ~. <br />ANNUAL REPORT `~ <br />~. <br />.~ <br />OPERATION NAME: Goldman Gravel Pit ~~~0 <br />ANNNERSARY DATE: November 22, 1999 QIEG~ <br />1999 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $225.00 ~~~ ~ ~ &~o`~ <br />COUNTY: Garfield O\~5\o~o~M~~t~ <br />PERMITTEE NAME: Flag Resources Inc <br />PERMIT NO.: M-78-279 <br />According to C.R.S. 3432; 1~(~),.each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a port and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation [hat will be performed during the coming <br />year, the dates for the beginning of active operations, and the date active operations ceased for the year, <br />if any. <br />Please attach your revised annual report map and written report to this annual report. Please <br />note that nn adequntely labeled map tlrnt clearly delineates and includes the above elements may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: Fi2F0 F2~/ <br />Company: ~i.A4 SA-r-D $~iRAd6~ <br />Adddress: ICI r'Z Loa..-7 2oaa all <br />NSW CAST'tr; Co 8141/ <br />Phone No.: (970) 117E ' Z 3 9 7 <br />Fax No.: (9b) 876 5 Z 3 z <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />~~ /~ <br />Signa ure of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />